Sunday, August 30, 2009

A Report from the Trenches

But I must begin once again with the matter that has quadrupled the traffic here at historyunfolding: the totally fraudulent email that has been circulating since around April, attributing a right-wing rant comparing President Obama to Adolf Hitler to myself. May I ask anyone who has received it to go back to the email they received, hit "reply all," and inform all recipients that it is a forgery whose origins are explained at snopes.com.

About ten days ago, after blogging about the failure of Democrats to organize for health care, I emailed both my Senators, Jack Reed and Sheldon Whitehouse, asking them to stand firmly for the public option. My reward last Monday was an invitation to attend a town hall in the northern part of the state which both of them planned to attend. It took place on Wednesday evening at a senior center and proved to be a most educational experience.

I arrived a little later than I had planned and only barely managed to find a parking space. A small contingent of right-wingers was on hand with signs and literature at the door, including some followers of Lyndon Larouche, who twenty years ago competed with the hare krishnas for space at unsecured airports. Spaghetti, meatballs and salad were provided, and I stood up rather than retreat into a distant corner where there might be a chair. Both Senators were in shirtsleeves and tieless. I was very proud of them both.

They began the way the argument should be done: health reform isn't an experiment or a question of doing good, it's a necessity. Whitehouse gave some of the chilling figures (I didn't take notes) on escalating costs. As I recall, our spending on health care has doubled in less than a decade and is on the pace to do the same. This has put a crippling economic burden on many businesses, led, of course, by the auto industry. Meanwhile, the number of uninsured is increasing (and that, as we learned later, is actually contributing significantly to increased costs.) Then came questions. The crowd, naturally, was composed of a majority of seniors, but included a number of young people as well.

The first question--and probably the majority of them--came from a dedicated, hostile conservative, who protested that at previous meetings, both Senators had expressed their support for the bill. While he complained bitterly that he and others did not want the bill passed and did not want the government messing in his health benefits, he (and many subsequent questioners) never acknowledged that there might be a substantial constituency of Americans who disagreed with him, or even bothered to threaten the two Democrats with a loss of support in the next election. His own righteousness, it seemed, should be enough to determine their vote. Both replied very calmly that they thought that something had to be done. Quite a few of the conservative questioners routinely mischaracterized the bill, making statements that simply assumed that it constituted a government takeover of the health care system. Some seniors talked that way too. Whitehouse and Reed did allow themselves the luxury of asking everyone what health benefit they had, and when many seniors replied, "Medicare," there were chuckles around the room.

Foreign health care systems came up. A 75-year old immigrant from Germany explained that his adult life had been evenly split between there and the United States, and spoke up for the kind of guaranteed care his homeland offered. "Many Americans," he said, "think they have insurance until they suddenly need it." He added that his wife's small business had had to stop offering coverage because it had become too expensive. But a younger woman, who had with her a young son who she said had cerebral palsy, claimed to have spent some time in Britain under the National Health system, and talked about how hard it was to get an appointment and how afraid she was to cancel it. (I began to wonder, on my way home, about that story, and whether in fact temporary residents can take advantage of British national health. Any comments would be appreciated.) The conservative opposition maintained an undertone of anger throughout the whole meeting, groaning, exclaiming, and challenging the two very unflappable elected officials at every turn.

Yet it gradually became clear that there were plenty of Administration supporters at the meeting as well--including several health care professionals. One nurse talked about the expense of care, and referred specifically to "what is done to patients, not for patients." In response, Senator Whitehouse talked about a move a few years back (when he was a state official) to upgrade intensive care units around the state. A half million dollars of new equipment, he said, could potentially save millions of dollars a year--and hospital administrators had actually said that it would not be easy for them to sacrifice such a large revenue stream! A young doctor, who supported reform and even a single-payer system, quoted an older doctor to the effect that he couldn't understand why he had been so opposed to Medicare, since it had made him so much money. He also told an amazing story of a patient without insurance who needed a month or two of continuous treatment for an infection of some time. Because he lacked insurance, the patient was not eligible for treatment at home and would spend that time in the hospital, at enormously increased cost. Several people spoke in favor of a single-payer system but the Senators said that it was simply not possible politically.

The crowd also included about five white-coated medical students from Brown University, and Whitehouse called on them. They spoke up very effectively for reform and cost control as well. It was interesting, it occurred to me, that while half a century ago doctors were leading the opposition to Medicare, now the insurance companies had become the main stumbling block to reform. I am also seeing and hearing more and more stories, including a recent one about stents on NPR, indicating a great deal of disagreement among doctors about how, and why, patients are given expensive care. By this time I was hoping to be called upon and had decided what I was going to say.

I was among the last called. The questioner before me was an elderly woman (though a most energetic one) who had printed out eight talking points from a conservative website, and who insisted upon reading them all. (By the time she got to "five" the crowd was rumbling, but the Senators made no attempt to interrupt her and she was not to be deterred.) They tried to respond to several of them. Then Whitehouse called on me.

I identified myself and my home town and said that I have been living in Rhode Island for almost 20 years (I wanted to mention that because my accent does not show it), and that I felt very lucky to have two Senators who were trying to address this very serious problem in a calm and rational manner. First, I said, I wanted to say about a word about Medicare. I was a few years away from taking advantage of it, I said, but I was old enough to remember when it was passed. A coalition of Democrats and liberal Republicans passed it over the violent objections of conservatives who said that it was socialist, un-American, and liable to take away our freedom--an argument made in particular by Ronald Reagan in one of his standard speeches. "I hope everyone in this room," I said, "especially the undecided people here--all three of you [that got a good laugh]--will think about whether we would be better off if we had listened to the Barry Goldwaters and the Ronald Reagans and the Richard Nixons and never passed Medicare." (At that point, a few younger conservatives said, "Yes!") Then I turned to my own biggest complaint: the advertising of prescription drugs. I didn't mind, I said, that my benefit contributions and Medicare contributions were paying for other peoples' Cialis and Viagara, but I most certainly did mind that they were also paying for millions and millions of ads for those products that I saw every time I watched a major sporting event. Surely, I said, patients knew when something was wrong, and doctors should be able to prescribe the proper treatment. I asked how many people realized that the drug companies spend more money on marketing than on r & d. I said I was amazed this wasn't a bigger issue in the current debate. Reed replied that the only proposal on the table was one that would tax the money the drug companies spent on ads. Several people immediately approached me to say how much they agreed with that point.

The meeting concluded shortly thereafter and Reed, who lives in my town, approached me. I said the meeting confirmed my fear about the debate--"all the intensity is on the other side." He replied that that was why Ted Kennedy had been so sorely missed this year. I said some one had to take up the slack.

Kennedy's name brings up another issue which the Republicans have successfully made it a taboo to raise--the unknown amount of money spent on dubious care in the last year of life. A Times story on Friday on Kennedy's treatment made this point very effectively. Kennedy had the most common and most lethal form of brain tumor, for which there is no cure. Treatment improved some years ago when local radiation was substituted for irradiating the whole brain. But the chemotherapy he received was approved after a study showed that it improved median survival from one year to fourteen months. That such a result can lead to the approval of a drug--instead of an instruction to the drug company to keep working in the hopes of coming up with something better--is in my opinion a very significant symptom of what is wrong with American health care. Personally I am quite confident that if I had such a diagnosis I would be sure to find out how much the treatment could be expected to extend my life--and that if it could not, at least for some time, restore me to something resembling full health, I would refuse it. (Because of some diagnostic problems of my own a few years back, incidentally, I have been close enough to that situation to have had that belief tested in real life, and it held up.) Sadly, all the Republican lies about "death panels" have made it extremely difficult to even discuss these issues, but they are a big part of the problem.

With the help of that story, I plan to raise that question at another town hall some day. Meanwhile, the experience confirmed what I have been saying here in spades. The battle for reform is a battle between reason on the one hand and raw emotion on the other. A vote on reform, I think, would have produced a pretty evenly divided result in that meeting, and quite possibly a majority in favor. An applause meter would have registered a significant majority against. Face to face with their constituents, Whitehouse and Reed kept their cool as ably as any general under fire, and for that I admired them. But Reed was right: some one has to step into the void that the death of our Massachusetts neighbor has left.

14 comments:

Thank you for this very helpful report. I attended a healthcare reform meeting in CA where the pros and cons were presented very clearly, and the discussion was confined to the issues (to the degree possible.) The meeting gave me an opportunity to get real information about the issues. What a shame that some of these meetings get hijacked by right-wing protesters, preventing the kind of reasoned discussion that we need.

You talked about the care Ted Kennedy had before he died. As a human being, he deserved the best of care, though I think he was one of the most horrid persons in the country.

But I have some questions. Do you really believe that under a government controlled medical system, a 77 year old man with an inoperable, incurable brain tumor would have received the intensive care Sen. Kennedy received?

How can you be so trusting in a government that has bankrupted our retirement system, Social Security? Its so bankrupt and rife with fraud, that we have to supplement it with outside, free market choices, and we're not allowed to opt out? For all the money I've put into it, I'll be lucky to get anything out when become eligible in 22 years.

What about the state of government run education system? Since the Dept. Of Education has been created, our SAT scores have plummeted, so much so the tests had to be rewritten. Our educational standings, as compared to other countries has fallen. I am positive you have seen this in your profession. As I see it, this government agency has done nothing but fail.

Because the citizen you described in your post (the "dedicated, hostile conservative") wasn't perhaps quite prepared, or perhaps as articulate as yourself, he deserved your ridicule, however subtle and implied. In truth, sir, there are indeed a great many of us who instinctively know that a government run health care system will be a disaster. Not only financially, but in terms of quality and availablilty of care. Furthermore, I can find just as many in the health care field that oppose government run health care. One example is the vaunted Mayo Clinic.

It is mind boggling to me that someone of your education, obvious intelligence, and respected position in society can disregard the obvious.

Honestly, thank you for your blog. I appreciate that you put your own thinking into words for others to see. I'm doing the same in making a comment. You and I are both taking a risk of ridicule. I am consciously intending not to ridicule your thinking, only to question it.

You wrote:The battle for reform is a battle between reason on the one hand and raw emotion on the other.

Are you saying that you see or find no reasoning, no rationality on the part of those who oppose certain proposals within HR 3200?Can there not be reasonable objections to the public option proposal for example? Are you saying that at the town hall meeting you attended there was no reasoning, no rationality manifested in the views of those who were opposed to the specifics of HR3200, a bill that I am glad was not passed before the August recess without the scrutiny it is now receiving. In my experience I don't find that those scrutinizing the bill, those raising objections, and those asking for better ideas are demons.It seems to me that you are demonizing (raw emotion absent reasoning) those who don't think HR 3200 is a good bill.

Regarding NHS coverage of visitors to the UK: my wife and I lived in England from 1988-1992 and two of our children were born there. Although we had excellent health insurance through the American company that posted us there, we used NHS because it was what was readily available. And although we would have used our insurance to pay for the services rendered, the NHS had no way to determine fees or collect them because it found it took more bureacracy to sustain the billing infrastructure than to absorb the cost of a relatively small number of foreign visitors using the system.

While there were indeed problems with NHS' ability to treat people in a timely manner, the care was excellent. And because the profit motive of private industry was absent, healthcare providers focused more on making people well so they would not burden the system than putting them on lifelong maintenance drugs and treatment regimens because it was good for business.

Being currently self-[un]employed and without health insurance, I'd give anything be under something like the NHS now. I fall into that class of Americans who work to provide insurance for the wealthy through profits and the poor through taxes, yet I can't afford this luxury myself.

For the most part I like the way your write. It seems very logical and sincere. I gotta say though, this bill isn't the right way to go about it. It has been too obvious in the past administrations that big industry gets involved and makes it work for themselves. From bailouts to nobid contracts, where will all of this ‘reform’ take us?

I just don't trust them with more and more of my money. Costs will outpace current taxation. ie... taxes will then be increased across the board. Why can't we have HSA's and Tax Credits to the public? I made $9000 one year, and still bought a high deductable health insurace plan. $40 a month.

I agree, there is tons of garbage coming from the right. I think similar from the left due to the vague descriptions of what will really happen if this pasts. I have just about read this whole bill. A lot of it is vague. Why not some bulleted list of what you will get and what you won't. What it will cost and what it won't...

What about State programs and not a federal one? Oregon Health Plan / Medi-Cal… People would then have a choice on where the could live and pay for healthcare that way.

Will the Health Benefits Advisory Committee tell me what I need to dose myself with according to which plan I need?

Do you want the government, with a D is cybersecurity to have your medical and bank information? (SEC 1173A)

Are we going to talk with someone from the Health Benefits Adviosry Committee about how we are feeling? (SEC 1191)

Are they going to mandatorily ‘immunize’ my kids with HPV and Flu vaccines?

Will I be able to get herbal treatments?

It's nice to see you can have a homebirth at least (SEC. 1724 C).

All I am saying is it’s vague. Right now I can pay for my own care how I see fit. I am already taxed enough. Why not clean up what we have?

Makes a lot of sense to me. Thanks for this blog. I came here from searching to make sure you didn't write the email that is attributed to you about the President.

I, too, think reform is needed. I think the other side had the numbers to change things and they didn't. I am willing to give "the other side" the benefit of the doubt. I have to believe that if it turned out terrible the American people would demand more change and get it- so I'm not sure it will be the end of the world as some people claim it to be.

Insurance is going through the roof. Expenses are killing business. An NHR, IMO, would be great (everyone in the military enjoys an NHR of sorts...). And I totally agree that it makes no sense to give expensive treatment to dying people- I am going to have a living will that will see I'm not being kept alive just so no-one will feel like they are "death paneling" me.

In the interim, I intend to keep on investing heavily in health care companies. That is the only way I can think of to profit from the resistance to change-hype crowd.

Thank you for this post. I agree that this is not really an honest, intellectual debate.

I tried to attend a similar town hall meeting in our area, but there was very little space and a very large turn out. Undeterred, I submitted my questions via e-mail:

1) Private "Health Care Insurance" is, at best, an inefficient and superfluous billing system. More typically, it is a financial racket, skimming profits off the top of health care transactions, without adding any value. Why aren't the proponents of reform highlighting this aspect of the debate?2) We do need a coherent, effective universal health care system, but we can't afford to finance it through more foolish deficit spending. The funding should come from existing revenue (an oversimplification, ignoring redirecting private cash flows or implementing more taxes, but valid for the purpose of this question); we need to set priorities and live within our means. Therefore, why are we not discussing the obscenely large proportion of revenue currently going to military and defense-related spending in this context? That is, wouldn't it be prudent to redirect some of these funds to real health care (for the non-military US citizens, since the military personnel are already covered)?3) If the private health care insurance system is "good" then why doesn't the federal government use it for all the federal employees (including you, and the military & veterans, etc.) that have government-provided health care?4) How long can this nation survive on its current course? There are many warning signals - financial, economic, social, political - flashing bright red. If we can not do the right thing with health care will we have a sustainable socio-political system?

I’ll be surprised if I receive more than a form letter response to these (politically naive) questions, so in case you’re actually contemplating them here are the short answers – which, of course, you’ll probably not hear from a politician:

1) Because the current system is financially beneficial to most of the key players, despite where they profess to stand. Besides, they are covered. 2) Because the current system is financially beneficial to most of the key players, despite where they profess to stand. Besides, the military lobby is more powerful (and more dangerous?) than the 47 million uninsured. 3) Are you kidding? 4) Don’t worry – we should be able to keep this game going as long as we can keep you folks engaged in the contentious and entertaining distractions that we’ve substituted for mature discourse/debate and rational policy-making.

What the health care debate is doing is identifying the undeserving people. I have be one of the most undeserving people on the planet, but I get, I believe, very expert and affordable health care and I pay nothing for it.

It turns out, much to my surprise, that I need this assistance. There is some fundamental issue of humanity that goes to kindness towards others and providing practical assistance. We all have to decide what is important to us as individuals and communities.

I feel very sorry for those Americans who may it is true be admitted to Emergency but when there chronic health conditions have become acute. As I say I live in another country.

Although you and I have no common beliefs, I respect that you have a wonderful freedom in blogging under the first amendment. I hope that our beloved country can keep that, in spite of the current administration's desire to stifle the voice of opposition. by the way, polls across the country are showing that the majority of American's are very happy with their current coverage. Why over haul the entire system, when they could regulate insurance companies and fix the giant loop holes in the medicade system. keep up the blogging, and may we all!

I used to fashion myself as one of those "compassionate conservatives" that Bush used to talk about. No more - these days, it is becoming an embarrasment to call myself that. Since the election, the right wing has taken on an extremist, almost hysterical persona with everything the end of the world, "death panels" and on and on. Jeez, people... take a pill or something. I came to this page tracking down the veracity of the email that David wrote about (glad to hear he was not responsible for it).

Sorry for the windy introduction. All I really want to say is 1)I am actively involved in amimal rescue and we do our level best to make end-of-life decisions that consider the well-being of the patient first. It is unfortunate that people aren't allowed that same responsibility when dealing with a loved one. What I am trying to say is that end-of-life decisions belong solely to the patient and his loved ones and should be unfettered by laws. 2) I hope President Obama excersises some leadership tomorrow night in his address to Congress. It is obvious (at least to me) that our elected leaders will put politics first and results second. He needs to take charge one way or the other. Not saying I agree with him, just that he should act like a leader, not a consensus-maker.

Re NHS services in the U.K: Our daughter spent six months (2002-2003) as an undergrad student at Pembroke College in Cambridge. We were urged to purchase student health insurance coverage for her despite the presence of NHS in England, and we did so. It was a waste of money. She had one brief illness while there and did consult with a physician. As with David's experience above, she found the NHS the way to go, and also found that her "insurance" was more of a hindrance than help.

We are a blue collar couple in our late 50's. My husband is clinging to his physically demanding job despite severe rheumatoid arthritis that leaves him in pain at the end of each work day. Every time he sees his rheumatologist he's told to quit. He stays because our health insurance is tied to his job and because I also have a chronic condition that would go untreated without insurance. We have a profoundly autistic son who was just kicked off our insurance arbitrarily at age 22, despite our repeated compliance in providing physician's forms certifying that he is never going to be able to care for himself. If his care defaults to Medi-Cal, he will not be able to see his present neurologist for care of epilepsy and our area has no other neurologists who will accept Medi-Cal as payment. He will also be refused dental care (but cannot speak to tell us when his teeth hurt). We lost our home years ago as a result of having to pay childhood medical bills for our son during the very early years of the explosion of autism--years when insurance companies classified autism as a non-covered mental illness. Doctors in every specialty including family practice who accept Medi-Cal are all but nonexistent in our area. I'll be spending today working to again prove our autistic son's disability to the insurance company.

Meanwhile, our grad student daughter's (History, U.C. Irvine)insurance comes & goes, entirely dependent on when she is actively working as an instructor as opposed to periods of fellowship work on her PhD. She is the poster child for starving student; she's done it all on her own because she had to, but she is also only one serious illness away from losing all she has worked so hard for.

Our oldest son followed his father into a service trade and has a wife and two children. While the trade is one that blessedly has not yet experienced deep layoffs, our greatest collective fear as a family is loss of that all important job--not because we could not eat or pay the rent (we'd figure that out) but because we'd lose our health care.

Something must change, and I voted for change. I pray that President Obama hits this one out of the metaphorical park. We need it.

I arrived here as a result of that awful forwarded email. I'm glad I found your blog. I'm not a regular on any blog, but I enjoy your insight and will return!

I don't often respond directly to comments but I'm certainly going to respond to yours. I'm glad I was able to give you a forum, and I think I'm going to post the comment as a "guest post" right now, so that all the right-wingers drawn here by the email will see it. They need to. I wish I could figure out how to organize the millions of people like yourself. I hope you are emailing your Senators and Congressman at every opportunity. The future of the nation seems to be at stake in so many ways. . .

The discussion you enjoyed in Rhode Island is a miracle. I hope that most of the town hall meetings were at least as respectful as you experienced. I came to your blog because someone sent me the email attributed to you. I wrote back to him to retract this message and to tell the other people he sent this misinformation. He refused. I told him that he was participating in a hoax and spreading lies on the Internet. He wrote to me that he did not care, because he agreed with the statements. Not only is this person being intellectually dishonest, he is spreading a hoax that may hurt someone. I am losing my respect for this man. He is a veteran from World War II and the only "news" he gets is from Rush Limbaugh and Fox News.

Our best hope is for the young people in America to think for themselves and avoid these right wing ideologs who spout slogans that are against their own best interests and against what is good for America.

About Me

Since 1976 I have been a historian of international and domestic politics, as well as an authority on some of the more famous criminal cases in American history. For the past eight years I have been using this space to comment on current events. Links to my books, including, The Road to Dallas: The Assassination of John F. Kennedy (2008), appear above, at the top right corner of this page.. Simply click to learn more about them or to order them.
The email circulating widely attributed to me comparing President Obama to Adolf Hitler is a forgery: see snopes.com/politics/soapbox/proportions.asp.
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